Dyspnea or shortness of breath is an uncomfortable feeling and can be experienced as a scary symptom. It is a feeling of tightening of chest, for want of more air and may be accompanied with frightening. Have you ever thought what can make you short of breath? Well, there are many causes that can lead to dyspnea or make you short of breath, which need to be evaluated properly.
Falling short of breath can commonly occur in any person, under certain circumstances. However, dyspnea or being short of breath can be a symptom of an underlying medical condition. Just as there are common occurrences when you can be short of breath, there are medical ailments, which can make you short of breath. It is important to understand the cause of dyspnea or what makes you short of breath, to be able to control the symptoms and treat the underlying medical cause.
While shortness of breath may be experienced by different people in a different manner, it is common to have a feeling of suffocation and discomfort in breathing. Dyspnea or being short of breath may be accompanied with other symptoms or may be an isolated complaint. Some people might feel suffocated or breathless on exerting themselves, while some may feel with little or no work. Dyspnea is classified into stages, known as grades, which is helpful in identifying and managing the condition.
Grades of Dyspnea
Dyspnea can be classified or graded into stages, depending on the severity of the complaint. The stages of dyspnea are evaluated considering the subjective or objective signs and symptoms. These can include the condition of the heart, which the physician assesses and the functional aspect, which the person actually experiences. As a general idea, the grades of dyspnea or shortness of breath include:
- Grade I – Dyspnea or being short of breath only on exertion, running, exercising or after doing activities that need extra effort.
- Grade II – Dyspnea or being short of breath on performing regular activities or doing ordinary effort, like walking up a hill.
- Grade III – Dyspnea or being short of breath on doing less than ordinary work. For e.g. walking, which leads to walking at slower pace than others of the same age and has to stop to catch breath.
- Grade IV – Dyspnea or being short of breath even when at rest. The person may find it difficult to leave the house or may be short of breath even with personal care activities.
Dyspnea can be categorized on the basis of the duration for which you feel short of breath and the severity of the condition. These include acute dyspnea or acute shortness of breath and chronic dyspnea or chronic shortness of breath. Acute dyspnea or shortness of breath usually occurs suddenly and last for few minutes, while chronic dyspnea last for few hours to weeks and is considered as a long standing complaint.
Symptoms of Dyspnea or What Happens If You Are Short of Breath
Dyspnea or being short of breath, although a common symptom, the exact way of occurrence may not be clearly understood in all cases. Dyspnea is felt as an uncomfortable feeling when breathing, which makes respiration difficult. In some cases, this uncomfortable feeling and shortness of breath may be a result of exposure to certain substances or chemicals. The possible mechanisms that cause dyspnea is the interaction between the respiratory function, cardiovascular functioning, responses from the neural receptors and the oxygen carriers.
Dyspnea or being short of breath may be a short lived, which is an episodic experience, which soon resolves or can be managed effectively. These generally result from allergies and infections. Shortness of breath can result from various causes and some of them can be due to serious medical ailments.
Causes of Dyspnea: What Makes You Short of Breath?
What causes dyspnea or what makes you short of breath mainly depends on any underlying medical condition that you may be experiencing. The way in which your symptoms develop and the pattern of feeling short of breath can give some idea about the possible causes of dyspnea. Acute shortness of breath usually develops suddenly within few minutes to hours and rapidly progresses. While chronic shortness of breath develops gradually over a period of few weeks or months. The causes for being short of breath differ in both.
Some common causes of dyspnea or shortness of breath must be considered. There are many conditions that can lead to dyspnea. Shortness of breath can be a result from respiratory, cardiac, neurogenic or other causes. Some causes that can make you short of breath are given here.
Respiratory Causes of Dyspnea or Shortness of Breath
Respiratory conditions can lead to dyspnea that can make you short of breath, whether acute or chronic in nature.
Acute Episodes of Obstructive Lung Diseases – An acute exacerbation of the obstructive lung diseases like asthma, chronic obstructive pulmonary disease (COPD), emphysema can cause dyspnea or shortness of breath. These can cause acute episodes of dyspnea as well as cause chronic shortness of breath, depending on the triggers.
In acute dyspnea, it results in sudden onset of being short of breath or difficulty in breathing after exposure to stimuli like upper respiratory infections, allergens like smoke, dust, peculiar fragrances, etc. These can also be triggered by cold air, exercise or sudden exertion. The triggering factors result in bronchospasms, making the exchange of air difficult and can make you short of breath. Cold and cough may be associated with it; wheezing may be noted, with a feeling of being short of breath.
Chronic Episodes of Obstructive Lung Diseases In chronic dyspnea, there may be a history of previous exposure to smoke or a history of long term smoking. Along with wheezing and long term dyspnea or being short of breath, there may be changes in the shape of the chest, making it barrel shaped chest, the lung capacity may be reduced and air entry and exit may be affected, which is revealed on examination.
Diagnosis often includes clinical examination, chest x-ray, other advanced imaging studies like CT scan and pulmonary function test (PFT) may be considered, if appropriate. Treatment usually includes bronchodilators, anti-allergic medications and other specific treatment based on the type and severity of the condition.
Pulmonary Embolism as a Cause of Dyspnea or Being Short of Breath
Pulmonary embolism occurs when a blood clot elsewhere in the body, gets detached from the walls and travels to the blood vessels in the lungs, thus blocking the artery in the lungs. Pulmonary embolism can be one of the possible causes that can make you short of breath or result in dyspnea. This can occur in persons who are immobilized for a long period, those who have undergone recent hospitalization or surgery or those with a family history. Certain conditions like pregnancy, cancer, deep vein thrombosis or other circulatory problems and regular consumption of medications like estrogen containing pills, oral contraceptive pills, etc. can increase the risk of pulmonary embolism, which can make you short of breath or result in dyspnea.
Diagnosis is made by history taking, clinical examination, CT scan and CT angiography.
Pneumothorax is a condition in which abnormal air or gas gets collected in the pleural spaces, which can affect normal breathing. Such condition can make you feel short of breath and the symptoms may begin suddenly, with sharp pain in the chest. The breathing becomes difficult and dyspnea is felt. It can occur following an injury to the chest, can occur all of a sudden or can be noted in people with chronic obstructive lung disease.
Diagnosis of this condition causing dyspnea can be made with chest x-ray and other scans.
Respiratory infections that affect the lungs can result in dyspnea or make you short of breath. Shortness of breath due to respiratory infections can be caused by various agents like viral, bacteria and can result in acute dyspnea or even cause long term chronic dyspnea. Common infections affecting the lower respiratory tract, like pneumonia, bronchitis, tuberculosis and others can cause dyspnea and make you short of breath. Fever is often an associated complaint. Depending on the nature of infection, dyspnea can be acute or chronic and can make you short of breath for a short period or for a longer period.
Diagnosis is based on the possible infections based on clinical presentation and the pattern of dyspnea or shortness of breath. Blood investigations and laboratory tests are done to detect the presence of infection. Specific tests may be performed to find the causative organism.
Acute respiratory distress syndrome (ARDS) is a condition in which a person may feel short of breath or develop acute dyspnea making breathing difficult. This is accompanied with reduced oxygen and it usually occurs after a triggering event like injury, infection, sepsis, aspiration, huge transfusion or in some cases, drug overdose.
This condition mostly results in acute dyspnea or makes you short of breath suddenly for a short time.
Diagnosis of dyspnea caused by ARDS is based on history of triggering event, blood investigations, chest-ray and CT scan.
Anaphylaxis is a sudden reaction of the entire body, in which many organs and systems are involved, as a response to certain stimuli. It can result from inhalation of certain toxic gases, which damage the respiratory passages and other parts of the body. The common systems involved include cardiovascular, respiratory, gastrointestinal systems and skin, depending on the mode of exposure. Symptoms may include blocking of nasal passages, nasal congestion, running nose, cough and hoarseness. When lower respiratory tract gets involved, bronchospasm can cause reduced oxygen, swelling of the respiratory tract causing difficulty in breathing. This can result in dyspnea or make you short of breath and often needs immediate medical attention.
Diagnosis of Anaphylaxis causing dyspnea can be made with history of sudden exposure and clinical examination. Investigations may include chest x-rays and arterial blood gas (ABG) analysis, if appropriate.
Inhalation or impaction of foreign body in the respiratory passage can cause cough, shortness of breath or dyspnea and change in voice. This is more common in children but can make you short of breath.
Restrictive Lung Disease
Restrictive lung diseases, which usually affect pleural or extra pulmonary areas and can cause pulmonary fibrosis can cause dyspnea. Symptoms include cough, breathing difficulty and dyspnea or being short of breath. This usually results in chronic dyspnea.
Diagnosis can be made based on personal history and clinical examination. Investigations like chest X-ray, CT scan and pulmonary function test can help to understand the severity of the condition that makes you short of breath.
Interstitial Lung Disease (ILD)
Interstitial lung disease is a group of respiratory disorders that affect the lungs and some specific tissues in it. Symptoms of ILD often include cough and dyspnea, which can make you short of breath. This is a chronic condition and often results in chronic type of dyspnea or shortness of breath.
Diagnosis of ILD may need specialized tests; however, the probable condition causing dyspnea can be assessed with clinical evaluation, chest x-ray and specialized CT scans.
Pleural effusion is a condition in which fluid gets accumulated in pleural spaces, which are the coverings of the lungs. This condition can result from exposure to pollutants, occupational hazards for a long period or from conditions affecting the liver, hepatitis, alcoholism, pancreatitis, etc. Symptoms of pleural effusion include chest pain, cough or dyspnea and can make you short of breath.
Diagnosis of pleural effusion as the cause of dyspnea can be done using chest X-ray and CT scan. Blood investigations may be done to detect other related conditions. Pleural tapping is often done to aspirate the accumulated fluid, which is sent for laboratory analysis, based on which further treatment is planned.
Cardiac Causes of Dyspnea or Shortness of Breath
Cardiac conditions that can make you short of breath include the following.
Dyspnea of Shortness of Breath Caused Due to Acute Myocardial Infarction
Myocardial infarction or ischemia is a condition in which, blood supply to the heart is temporarily obstructed, which can lead to death of some cells in the heart tissue. This can cause angina or chest pain or feeling of pressure on the chest. Acute myocardial infarction is an important cause of dyspnea or can make you short of breath along with severe pain in chest or nearby areas. The pain can radiate to jaw, neck, arms and shoulders, symptoms of nausea, difficulty in swallowing, sweating may also be present and associated dyspnea is an important characteristic feature.
Diagnosis can be made with electrocardiogram (ECG) and other specialized cardiac investigations. Some investigations may include assessing cardiac enzyme levels to detect myocardial infarction causing dyspnea.
Dyspnea of Shortness of Breath Caused Due to Muscle Dysfunction
Muscular dysfunction of the heart muscle can lead to chest pain and acute dyspnea or shortness of breath. While this can occur with an increased risk in persons who have had myocardial infarction, this too is one of the possible causes that can make you short of breath.
Diagnosis of this condition causing dyspnea can be made by clinical examination and echocardiography.
This condition is characterized by disturbed cardiac functioning and often presents with dyspnea during the night. This can make you feel short of breath particularly more during the night or when lying down. This is usually a long term shortness of breath or chronic dyspnea. Diagnosis of the condition that can cause dyspnea can be made with clinical examination, chest x-ray, cardiac scans and echocardiogram.
This condition occurs when fluid gets accumulated in the pericardial spaces, which are the coverings of the heart. Symptoms of pericardial effusion may include dyspnea or shortness of breath along with other cardiac findings during clinical examination. Diagnosis of dyspnea due to pericardial effusion can be made with echocardiography.
This condition is marked with dyspnea, increase heart rate and often presents with other signs that need to be evaluated.
Other cardiac conditions like arrhythmias, aortic stenosis, etc. too can cause dyspnea and make you short of breath.
Other Causes of Dyspnea or Shortness of Breath
Other, but common causes that can make you short of breath are included here.
Anemia is a condition characterized with low hemoglobin count in blood. Symptoms of anemia include weakness, fatigue and sometimes fainting along with dyspnea. Anemia is a very common condition that can make you short of breath with a feeling of being exerted all the time. Dyspnea or shortness of breath in anemia often begins with feeling short of breath on exertion initially and may gradually progress to feeling short of breath even while at rest.
Diagnosis can be made by blood investigation, which shows low hemoglobin count. Pulmonary tests, chest x-rays are done to rule out involvement of lung related conditions. Cardiac evaluation may also be done to find the cause that makes you short of breath and sometimes murmur or abnormal sounds in between the heart beats can be noted. Treatment includes iron supplementation to bring hemoglobin levels back to normal.
Trauma to the chest wall, fracture of ribs or injuries that affect the lungs or the pulmonary system can cause dyspnea and make you short of breath.
This is a serious condition that requires immediate medical attention. Choking occurs due to lodging of a food substance or any other substance in the food pipe, which blocks the passage and can cause dyspnea.
Sedentary lifestyle or physical deconditioning is another common reason that can make you short of breath or cause dyspnea. This usually occurs when a person has been resting for a long periods of time, may be during recovery periods, prolonged immobilization or bed rest during pregnancy.
These conditions causing dyspnea can be evaluated on clinical examination, history of existing or previous medical conditions. While investigations may not be required, relevant tests may be ordered, if found appropriate.
Being overweight is one of the commonest causes that can make you short of breath and experience dyspnea on slight exertion. This may also be accompanied with fatigue and lack of activity or stamina to perform routine tasks. Reducing weight and following a healthy diet and exercise pattern is important.
Sometimes anxiety or panic attacks can cause difficulty in breathing and make you short of breath, mostly accompanied with sudden fright, palpitations and sweating.
Hypothyroidism can affect respiratory function, cause dyspnea and can make you short of breath.
Disorders of the neuromuscular system, like myasthenia gravis, sclerosis or conditions that cause hyperventilation or increase intracranial pressure can lead to dyspnea or shortness of breath.
Other conditions like low blood pressure, sudden loss of blood, certain congenital syndromes or carbon monoxide poisoning, can cause dyspnea or make you short of breath.